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Hristov AC, Tejasvi T, Wilcox RA. Cutaneous T-cell lymphomas: 2023 update on diagnosis, risk-stratification, and management. Am J Hematol 2023; 98:193-209. [PMID: 36226409 PMCID: PMC9772153 DOI: 10.1002/ajh.26760] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 02/04/2023]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or the blood involvement are generally approached with systemic therapies, including biologic-response modifiers, histone deacetylase inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Alexandra C. Hristov
- Departments of Pathology and Dermatology, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109-2800
| | - Trilokraj Tejasvi
- Department of Dermatology, 1910 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Ryan A. Wilcox
- Correspondence to: Ryan Wilcox, MD, PhD, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, 1500 E. Medical Center Drive, Room 4310 CC, Ann Arbor, MI 48109-5948, Phone: (734) 615-9799, Fax: (734) 936-7376,
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2
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Clonotype pattern in T-cell lymphomas map the cell of origin to immature lymphoid precursors. Blood Adv 2022; 6:2334-2345. [PMID: 35015812 PMCID: PMC9006294 DOI: 10.1182/bloodadvances.2021005884] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022] Open
Abstract
Mature T-cell lymphomas (TCLs) are rare, clinically heterogeneous hematologic cancers of high medical need. TCLs have inferior prognosis which is attributed to poor understanding of their pathogenesis. Based on phenotypic similarities between normal and neoplastic lymphocytes it has been assumed that TCLs develop in the periphery, directly from various subtypes of normal T-cells. To address the debated question of the cell of origin in TCLs we analyzed to identify the highly variable complementarity determining regions (CDR3) regions of T-cell receptor (TCR) to trace the clonal history of the T-cells. We have collected previously published whole genome -exome, and -transcriptome sequencing data from 574 TCL patients. TCR clonotypes were identified by de novo assembly of CDR3 regions of TCR γ, β and α. We have found that the vast majority of TCLs are clonotypically oligoclonal, although the pattern oligoclonality varied. Anaplastic large cell lymphoma was most diverse comprising multiple clonotypes of TCRγ, β and α whereas adult T-cell lymphoma/leukemia and peripheral T-cell lymphomas often showed monoclonality for TCRγ and β but had diverse TCRα clonotypes. These patterns of rearrangements indicated that TCLs are initiated at the level of the lymphoid precursor. In keeping with this hypothesis, TCR rearrangements in TCLs resembled the pattern seen in the human thymus showing biased usage of V and J segments of high combinatorial probability resulting in recurrent, "public" CDR3 sequences shared across unrelated patients and different clinical TCL entities. Clonotypically diverse initiating cells may seed target tissues being responsible for disease relapses after therapy.
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3
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Hristov AC, Tejasvi T, Wilcox RA. Cutaneous T-cell lymphomas: 2021 update on diagnosis, risk-stratification, and management. Am J Hematol 2021; 96:1313-1328. [PMID: 34297414 PMCID: PMC8486344 DOI: 10.1002/ajh.26299] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/08/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with systemic therapies, including biologic-response modifiers, histone deacetylase inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Alexandra C. Hristov
- Departments of Pathology and Dermatology, North Campus Research Complex, Ann Arbor, Michigan, USA
| | - Trilokraj Tejasvi
- Director Cutaneous Lymphoma program, Department of Dermatology, A. Alfred Taubman Health Care Center, Ann Arbor, Michigan, USA
| | - Ryan A. Wilcox
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
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4
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Oberbeck S, Schrader A, Warner K, Jungherz D, Crispatzu G, von Jan J, Chmielewski M, Ianevski A, Diebner HH, Mayer P, Kondo Ados A, Wahnschaffe L, Braun T, Müller TA, Wagle P, Bouska A, Neumann T, Pützer S, Varghese L, Pflug N, Thelen M, Makalowski J, Riet N, Göx HJM, Rappl G, Altmüller J, Kotrová M, Persigehl T, Hopfinger G, Hansmann ML, Schlößer H, Stilgenbauer S, Dürig J, Mougiakakos D, von Bergwelt-Baildon M, Roeder I, Hartmann S, Hallek M, Moriggl R, Brüggemann M, Aittokallio T, Iqbal J, Newrzela S, Abken H, Herling M. Noncanonical effector functions of the T-memory-like T-PLL cell are shaped by cooperative TCL1A and TCR signaling. Blood 2020; 136:2786-2802. [PMID: 33301031 PMCID: PMC7731789 DOI: 10.1182/blood.2019003348] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a poor-prognostic neoplasm. Differentiation stage and immune-effector functions of the underlying tumor cell are insufficiently characterized. Constitutive activation of the T-cell leukemia 1A (TCL1A) oncogene distinguishes the (pre)leukemic cell from regular postthymic T cells. We assessed activation-response patterns of the T-PLL lymphocyte and interrogated the modulatory impact by TCL1A. Immunophenotypic and gene expression profiles revealed a unique spectrum of memory-type differentiation of T-PLL with predominant central-memory stages and frequent noncanonical patterns. Virtually all T-PLL expressed a T-cell receptor (TCR) and/or CD28-coreceptor without overrepresentation of specific TCR clonotypes. The highly activated leukemic cells also revealed losses of negative-regulatory TCR coreceptors (eg, CTLA4). TCR stimulation of T-PLL cells evoked higher-than-normal cell-cycle transition and profiles of cytokine release that resembled those of normal memory T cells. More activated phenotypes and higher TCL1A correlated with inferior clinical outcomes. TCL1A was linked to the marked resistance of T-PLL to activation- and FAS-induced cell death. Enforced TCL1A enhanced phospho-activation of TCR kinases, second-messenger generation, and JAK/STAT or NFAT transcriptional responses. This reduced the input thresholds for IL-2 secretion in a sensitizer-like fashion. Mice of TCL1A-initiated protracted T-PLL development resembled such features. When equipped with epitope-defined TCRs or chimeric antigen receptors, these Lckpr-hTCL1Atg T cells gained a leukemogenic growth advantage in scenarios of receptor stimulation. Overall, we propose a model of T-PLL pathogenesis in which TCL1A enhances TCR signals and drives the accumulation of death-resistant memory-type cells that use amplified low-level stimulatory input, and whose loss of negative coregulators additionally maintains their activated state. Treatment rationales are provided by combined interception in TCR and survival signaling.
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MESH Headings
- Animals
- Humans
- Immunologic Memory
- Leukemia, Prolymphocytic, T-Cell/genetics
- Leukemia, Prolymphocytic, T-Cell/immunology
- Leukemia, Prolymphocytic, T-Cell/pathology
- Mice
- Mice, Knockout
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/immunology
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Signal Transduction/genetics
- Signal Transduction/immunology
- T-Lymphocytes/immunology
- T-Lymphocytes/pathology
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Affiliation(s)
- S Oberbeck
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - A Schrader
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - K Warner
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - D Jungherz
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - G Crispatzu
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - J von Jan
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - M Chmielewski
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - A Ianevski
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - H H Diebner
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry Dresden, Technische Universität Dresden, Dresden, Germany
| | - P Mayer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - A Kondo Ados
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - L Wahnschaffe
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - T Braun
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - T A Müller
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - P Wagle
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
| | - A Bouska
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - T Neumann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - S Pützer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - L Varghese
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - N Pflug
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
| | - M Thelen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - J Makalowski
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - N Riet
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - H J M Göx
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
| | - G Rappl
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - J Altmüller
- Cologne Center for Genomics, Institute of Human Genetics, UoC, Cologne, Germany
| | - M Kotrová
- Medical Department II of Hematology and Oncology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - T Persigehl
- Department of Radiology, UoC, Cologne, Germany
| | - G Hopfinger
- Center for Oncology and Hematology, Kaiser-Franz-Josef-Spital, Vienna, Austria
| | - M L Hansmann
- Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - H Schlößer
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - S Stilgenbauer
- Department III of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - J Dürig
- Clinic for Hematology, University Hospital Essen, Essen, Germany
| | - D Mougiakakos
- Department of Medicine 5, Hematology, and Oncology, University Hospital Erlangen, Erlangen, Germany
| | | | - I Roeder
- Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry Dresden, Technische Universität Dresden, Dresden, Germany
| | - S Hartmann
- Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - M Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
| | - R Moriggl
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine, Vienna, Austria
- Ludwig Boltzmann Institute for Cancer Research, Medical University of Vienna, Vienna, Austria; and
| | - M Brüggemann
- Medical Department II of Hematology and Oncology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - T Aittokallio
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - J Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - S Newrzela
- Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - H Abken
- RCI Regensburg Center for Interventional Immunology, Regensburg, Germany
| | - M Herling
- Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf
- CECAD Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases, and
- Center for Molecular Medicine Cologne, University of Cologne (UoC), Cologne, Germany
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Hristov AC, Tejasvi T, Wilcox RA. Mycosis fungoides and Sézary syndrome: 2019 update on diagnosis, risk-stratification, and management. Am J Hematol 2019; 94:1027-1041. [PMID: 31313347 DOI: 10.1002/ajh.25577] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 01/04/2023]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, skin-directed therapies are preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with systemic therapies. These include biologic-response modifiers, histone deacetylase (HDAC) inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Alexandra C. Hristov
- Departments of Pathology and DermatologyUniversity of Michigan Ann Arbor Michigan
| | | | - Ryan A. Wilcox
- Division of Hematology/Oncology, Department of Internal MedicineUniversity of Michigan Rogel Cancer Center Ann Arbor Michigan
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6
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Wilcox RA. Cutaneous T-cell lymphoma: 2017 update on diagnosis, risk-stratification, and management. Am J Hematol 2017; 92:1085-1102. [PMID: 28872191 DOI: 10.1002/ajh.24876] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors prior to escalating therapy to include systemic, single-agent chemotherapy. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan 48109-5948
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7
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[Diagnostics of primary cutaneous lymphomas]. Hautarzt 2017; 68:696-701. [PMID: 28779267 DOI: 10.1007/s00105-017-4020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Primary cutaneous lymphomas can be diagnosed when the clinical symptoms, histology, immunohistology and molecular biological changes are characteristic of primary cutaneous T or B‑cell lymphomas; however, in many cases not all of the changes are typical of a primary cutaneous lymphoma especially in the early stages; therefore, the diagnosis of a primary cutaneous lymphoma can be a challenge. This is especially true for the Sézary syndrome, which can initially prove to be difficult to differentiate from reactive erythroderma; therefore, the main focus of this review is the diagnostics of Sézary syndrome. The review also summarizes the clinical heterogeneity and describes the classical histological and immunohistochemical changes for the diagnosis of Sézary syndrome. Recent data from different multicenter, international studies by the cutaneous lymphoma task force of the European Organisation for Research and Treatment of Cancer (EORTC) on dermatological alterations of the skin and the detection of Sézary cells in blood are addressed. The detection of Sézary cells in the blood still remains a challenge despite improved molecular boiological and cytogenetic characterization of tumor cells. The latest studies of the EORTC group particularly identified CD158k, MYC, MNT, DNM, TWIST1, EPHA4 and PLS3 as valuable markers for the differentiation of reactive erythroderma but which are not yet part of the standard diagnostics of Sézary syndrome. Further studies are required to see if these markers can be used in the routine clinical application.
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8
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Wilcox RA. Cutaneous T-cell lymphoma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol 2016; 91:151-65. [PMID: 26607183 PMCID: PMC4715621 DOI: 10.1002/ajh.24233] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/03/2015] [Indexed: 12/11/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral, or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors before escalating therapy to include systemic, single-agent chemotherapy. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology, University of Michigan Cancer Center, 1500 E. Medical Center Drive, Room 4310 CC, Ann Arbor, MI 48109-5948
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9
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Wilcox RA. Cutaneous T-cell lymphoma: 2014 update on diagnosis, risk-stratification, and management. Am J Hematol 2014; 89:837-51. [PMID: 25042790 DOI: 10.1002/ajh.23756] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, and blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors prior to escalating therapy to include systemic, single-agent chemotherapy. Multiagent chemotherapy (e.g., CHOP) may be employed for those patients with extensive visceral involvement requiring rapid disease control. In highly selected patients, allogeneic stem-cell transplantation may be considered.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology; University of Michigan Cancer Center; Ann Arbor Michigan
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Warner K, Weit N, Crispatzu G, Admirand J, Jones D, Herling M. T-cell receptor signaling in peripheral T-cell lymphoma - a review of patterns of alterations in a central growth regulatory pathway. Curr Hematol Malig Rep 2014; 8:163-72. [PMID: 23892905 DOI: 10.1007/s11899-013-0165-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
T-cell receptor (TCR) signaling is pivotal in T-cell development and function. In peripheral T-cell lymphomas/leukemias (PTCL/L), histogenesis, transforming events, epidemiology, and clinical presentation are also closely linked to TCR-mediated influences. After reviewing the physiology of normal TCR signaling and cellular responses, we describe here the association of subgroups of PTCL/L with specific patterns of TCR activation as relevant tumor-initiating and/or tumor-sustaining programs. We identify PTCL/L with a functionally intact TCR machinery in which stimulation is possibly incited by exogenous antigens or autoantigens. Distinct from these are tumors with autonomous oncogenic signaling by dysregulated TCR components uncoupled from extrinsic receptor input. A further subset is characterized by transforming events that activate molecules acting as substitutes for TCR signaling, but triggering similar downstream cascades. We finally discuss the consequences of such a functional model for TCR-targeted therapeutic strategies including those that are being tested in the clinic and those that still require further development.
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Affiliation(s)
- Kathrin Warner
- Laboratory for Lymphocyte Signaling and Oncoproteome, Department I of Internal Medicine, Center for Integrated Oncology Köln-Bonn, Cologne, Germany
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Willerslev-Olsen A, Krejsgaard T, Lindahl LM, Bonefeld CM, A. Wasik M, B. Koralov S, Geisler C, Kilian M, Iversen L, Woetmann A, Odum N. Bacterial toxins fuel disease progression in cutaneous T-cell lymphoma. Toxins (Basel) 2013; 5:1402-21. [PMID: 23949004 PMCID: PMC3760043 DOI: 10.3390/toxins5081402] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/02/2013] [Accepted: 08/06/2013] [Indexed: 01/02/2023] Open
Abstract
In patients with cutaneous T-cell lymphoma (CTCL) bacterial infections constitute a major clinical problem caused by compromised skin barrier and a progressive immunodeficiency. Indeed, the majority of patients with advanced disease die from infections with bacteria, e.g., Staphylococcus aureus. Bacterial toxins such as staphylococcal enterotoxins (SE) have long been suspected to be involved in the pathogenesis in CTCL. Here, we review links between bacterial infections and CTCL with focus on earlier studies addressing a direct role of SE on malignant T cells and recent data indicating novel indirect mechanisms involving SE- and cytokine-driven cross-talk between malignant- and non-malignant T cells.
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Affiliation(s)
- Andreas Willerslev-Olsen
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Thorbjørn Krejsgaard
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Lise M. Lindahl
- Department of Dermatology, Aarhus University Hospital, Aarhus 8000, Denmark; E-Mails: (L.M.L.); (L.I.)
| | - Charlotte Menne Bonefeld
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Mariusz A. Wasik
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; E-Mail:
| | - Sergei B. Koralov
- Department of Pathology, NYU Langone Medical Center, New York, NY 10016, USA; E-Mail:
| | - Carsten Geisler
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Mogens Kilian
- Department of Biomedicine, Aarhus University, Aarhus 8000, Denmark; E-Mail:
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus 8000, Denmark; E-Mails: (L.M.L.); (L.I.)
| | - Anders Woetmann
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Niels Odum
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +45-3532-7879
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Abstract
INTRODUCTION NKG2D (natural killer group 2, member D) is expressed on the surface of all mouse and human NK cells, and subpopulation of T cells. Stimulation of NK cells through NKG2D triggers cell-mediated cytotoxicity and induces the production of cytokines. NKG2D binds to family of unique ligands with structurally similar to MHC class I, however, NKG2D ligands can be up-regulated in their expression on stressed cells including tumor cells unlike conventional MHC class I molecules. Mounting evidences clearly implicate that NKG2D recognition plays an important role in tumor immune surveillance. AREAS COVERED While NKG2D detect for potentially dangerous cells, various inhibitory and/or escape mechanisms counteract immune surveillance system and thereby limit effective elimination of transformed tumor cells. In addition, tumors often generate an immunosuppressive microenvironment where inhibitory molecules or cytokines negatively effect the function of anti-tumor immune responses. NKG2D ligand expression can be up-regulated by transcriptional or posttranscriptional mechanisms, therefore, certain therapy targeting those regulatory mechanisms could regain the expression of NKG2D ligands on tumor cells to be detected by the host immune responses. EXPERT OPINION Our knowledge in the precise mechanism of anti-tumor immunity is rapidly increasing. While NKG2D is known as primary cytotoxicity receptor in NK cell activation by recognizing 'induced-self' ligands on stressed cells including tumor cells, there are increasing evidences that NKG2D recognition can result in both immune activation and immune silencing. Future combined application of conventional cancer therapy and new therapy utilizing such stress-induced recognition systems will provide a novel opportunity to control malignant tumor progression of cancer disease.
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Affiliation(s)
- Yoshihiro Hayakawa
- The University of Tokyo, Graduate School of Pharmaceutical Sciences, Laboratory of Cancer Biology and Molecular Immunology, Bunkyo-ku, Japan.
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13
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Sproul AM, Goodlad JR. Clonality testing of cutaneous lymphoid infiltrates: practicalities, pitfalls and potential uses. J Hematop 2012. [DOI: 10.1007/s12308-012-0145-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Wilcox RA. Cutaneous T-cell lymphoma: 2011 update on diagnosis, risk-stratification, and management. Am J Hematol 2011; 86:928-48. [PMID: 21990092 DOI: 10.1002/ajh.22139] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY Tumor, node, metastasis, and blood (TNMB) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral, or blood involvement are generally approached with biologic-response modifiers, denileukin diftitox, and histone deacetylase inhibitors before escalating therapy to include systemic, single-agent chemotherapy. Multiagent chemotherapy may be used for those patients with extensive visceral involvement requiring rapid disease control. In highly-selected patients with disease refractory to standard treatments, allogeneic stem-cell transplantation may be considered.
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Affiliation(s)
- Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Cancer Center, Ann Arbor, 48109-5948, USA. rywilcox@med. umich.edu
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Zha X, Chen S, Yang L, Li B, Chen Y, Yan X, Li Y. Characterization of the CDR3 structure of the Vβ21 T cell clone in patients with P210BCR-ABL-positive chronic myeloid leukemia and B-cell acute lymphoblastic leukemia. Hum Immunol 2011; 72:798-804. [DOI: 10.1016/j.humimm.2011.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 06/21/2011] [Accepted: 06/27/2011] [Indexed: 12/23/2022]
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16
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Salem ML. Triggering of toll-like receptor signaling pathways in T cells contributes to the anti-tumor efficacy of T cell responses. Immunol Lett 2011; 137:9-14. [PMID: 21352854 DOI: 10.1016/j.imlet.2011.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/15/2011] [Accepted: 02/16/2011] [Indexed: 02/07/2023]
Abstract
Traditionally, expression of toll-like receptors (TLRs) has been associated with innate immune cells in particular professional antigen presenting cells and natural killer cells. This led to the concept that the adjuvant effects of ligation of TLR in a host occur mainly in innate immune cells. However, this concept has been challenged by recent studies including ours demonstrating that T cells express appreciated levels of different TLRs, which can serve as costimulatory co-receptors during polyclonal and antigen-specific stimulation of T cells. Because T cells express low levels of TLRs as compared to innate immune cells, increasing the expression levels of TLRs in T cells can significantly maximize their responses to the costimulatory effects of TLR ligation. This review article focuses on the potential role of TLR expression in T cells in their responses to vaccination regimen containing TLR agonists and how it can be modulated to optimize anti-tumor immunity.
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Affiliation(s)
- Mohamed Labib Salem
- Immunology and Biotechnology Unit, Department of Zoology, Tanta University, Egypt.
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van der Fits L, Sandberg Y, Darzentas N, Zoutman W, Tielemans D, Wolvers-Tettero I, Vermeer M, Langerak A. A restricted clonal T-cell receptor αβ repertoire in Sézary syndrome is indicative of superantigenic stimulation. Br J Dermatol 2011; 165:78-84. [DOI: 10.1111/j.1365-2133.2011.10308.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Luo W, Liao WJ, Huang YT, Shi M, Zhang Y, Wen Q, Zhou MQ, Ma L. Normalization of T cell receptor repertoire diversity in patients with advanced colorectal cancer who responded to chemotherapy. Cancer Sci 2011; 102:706-12. [DOI: 10.1111/j.1349-7006.2011.01868.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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TCRγ-Chain Gene Rearrangement by GeneScan: Incidence and Significance of Clonal Heterogeneity in Sézary Syndrome. J Invest Dermatol 2010; 130:2312-9. [DOI: 10.1038/jid.2010.97] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Evaluation of T-cell Clonality in Archival Skin Biopsy Samples of Cutaneous T-cell Lymphomas Using the Biomed-2 PCR Protocol. ACTA ACUST UNITED AC 2010; 19:70-7. [DOI: 10.1097/pdm.0b013e3181b2a1b7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Zhang B, Beck AH, Taube JM, Kohler S, Seo K, Zwerner J, Viakhereva N, Sundram U, Kim YH, Schrijver I, Arber DA, Zehnder JL. Combined use of PCR-based TCRG and TCRB clonality tests on paraffin-embedded skin tissue in the differential diagnosis of mycosis fungoides and inflammatory dermatoses. J Mol Diagn 2010; 12:320-7. [PMID: 20203005 DOI: 10.2353/jmoldx.2010.090123] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The distinction between mycosis fungoides (MF) and inflammatory dermatoses (ID) by clinicopathologic criteria can be challenging. There is limited information regarding the performance characteristics and utility of TCRG and TCRB clonality assays in diagnosis of MF and ID from paraffin-embedded tissue sections. In this study, PCR tests were performed with both TCRG and TCRB BIOMED-2 clonality methods followed by capillary electrophoresis and Genescan analysis using DNA samples from 35 MF and 96 ID patients with 69 and 133 paraffin-embedded specimens, respectively. Performance characteristics were determined for each test individually and in combination. TCRG and TCRB tests demonstrated identical sensitivity (64%) and specificity (84%) when analyzed as individual assays. The positive predictive value, negative predictive value, and change of posttest MF probability over a range of MF pretest probabilities were obtained. These data were used to construct an algorithm for sequential use of TCRG and TCRB. As single tests, commercially available BIOMED-2 PCR-based TCRG and TCRB clonality tests on paraffin-embedded tissue have no significant difference in terms of sensitivity and specificity. Combined use of the two tests in patients with intermediate pretest probabilities as proposed in the algorithm could improve test utility.
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Affiliation(s)
- Bing Zhang
- Department of Pathology, L235, Stanford University Medical Center, Stanford, CA 94305, USA
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Aplicación de los protocolos de PCR BIOMED-2 en el análisis genotípico de los linfomas cutáneos primarios. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74757-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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23
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Gallardo F, Bellosillo B, Serrano S, Pujol R. Genotypic Analysis in Primary Cutaneous Lymphomas Using the Standardized Biomed-2 Polymerase Chain Reaction Protocols. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Karenko L, Hahtola S, Ranki A. Molecular cytogenetics in the study of cutaneous T-cell lymphomas (CTCL). Cytogenet Genome Res 2007; 118:353-61. [DOI: 10.1159/000108320] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 11/30/2006] [Indexed: 01/06/2023] Open
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Liu H, Bench AJ, Bacon CM, Payne K, Huang Y, Scott MA, Erber WN, Grant JW, Du MQ. A practical strategy for the routine use of BIOMED-2 PCR assays for detection of B- and T-cell clonality in diagnostic haematopathology. Br J Haematol 2007; 138:31-43. [PMID: 17555445 DOI: 10.1111/j.1365-2141.2007.06618.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BIOMED-2 polymerase chain reaction (PCR) assays for clonality analysis of immunoglobulin (IG) and T-cell receptor (TCR) gene rearrangements were evaluated in routine haematopathological practice where paraffin-embedded tissues constitute the majority of specimens. One hundred and twenty-five fresh/frozen and 316 paraffin specimens were analysed for DNA quality and clonality. Seventy-nine per cent of paraffin specimens yielded PCR products of over 300 bp. These specimens and all fresh/frozen specimens were analysed with the complete set of BIOMED-2 reactions for IG (8 reactions) and/or TCR (6 reactions) gene rearrangements. The rate of detection of clonality was 96% in mature B-cell neoplasms and 98% in mature T-cell neoplasms and there were no significant differences in these rates between paraffin and fresh/frozen specimens. As the value of sole use of any individual BIOMED-2 reaction in clonality detection was limited, we assessed combinations of reactions that gave the greatest sensitivity with fewest reactions and were applicable for both fresh/frozen and paraffin specimens. For IG gene rearrangements, three reactions combining one targeting the IG heavy chain framework-2 region and two targeting the IG kappa locus achieved a 91% detection rate. For TCR gene rearrangements, the two TCR gamma reactions gave a 94% detection rate. We therefore recommend this strategy as the first-line assays for routine B- and T-cell clonality analysis in diagnostic haematopathology.
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Affiliation(s)
- Hongxiang Liu
- Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
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